MALIGNANT BONE TUMOR COMMON AGE GENDER SITE

OSTEOSARCOMA Children/adolescent (20s); older age (post-radiation, paget s disease) M>F Long bone metaphysic: knee (distal femur/ proximal tibia) & proximal ends of humerus Local pain + swelling (gradually ) + mass+ tender + limited ROM of affected joint

CHONDROSARCOMA >60 years of age M>F Femur, humerus, ribs & pelvis (primary tumor) Flat bone e.g scapula & pelvic bone (2ndry tumor) Pain + local swelling + mass + patho;ogical #

EWING S SARCOMA 10 20 years of age M>F Diaphysis of tubular bone (tibia, fibula & clavicle)

MULTIPLE MYELOMA 45 65 years of age M>F Skull, pelvis, ribs, proximal femur, vertebrae, bone metaphysis

CLINICAL FEATURES

Pain + swelling + generalized illness + pyrexia + warm, tender & swelling

PATHOLOGY

Most common 1 sarcoma of bone Arising within the bone, destroy the bones + spreading outwards to the periosteum + surrounding soft tissue

Malignant tumor derived from cartilage cells Primary: uncommon, centrally in the bone, children or secondary d/t benign chondroma/osteochondroma: Slow growing tumor Central chondrosarcoma: expanding lytic lesion + central flecks of calcification + cortex destruction Peripheral chondrosarcoma: soft tissue shadow growing outwards from the surface of bone + area of calcification X-ray MRI, CT Scan extent of tumor Biopsy

Uncommon, arise from endothelial cells in the bone marrow Large & lobulated Small round blue cells

Weakness, backache, bone pain, pathological #, Symptoms of anemia, Bleeding problems, Susceptible to infection, Symptom of hypercalcemia Spinal cord compress + renal probs Malignant B cell lymphoproliferative disorder of bone marrow monoclonal immunoglobulin (abnormal protein) marrow cell proliferation + osteoclast xtvt osteoporosis + lytic lesion Solitary lesion: plasmacytoma. But usually multiple lesion (myelomatosis) X-ray: bone destruction (moth-eaten appearance), multiple punched out lesion

RADIOLOGICAL FINDINGS

X-ray: osteolytic of the bone (alternate lytic & sclerosis; permeative lesion) + ill defined margin + breached cortex (sun burst) + periosteum reaction (Codman s triangle) X-ray, CT, MRI extent of tumor Chest X-ray/CT lung metastases Bone scan - uptake (skip lesion) Biopsy Blood test - ALP Hematogenous: common, to the lung, tumor more vascular Direct spread to surrounding soft tissue + medullary cavity of long bones Lymphatic : almost never occur d/t poor lymphatic supply to the bone Chemotherapy 8-12 weeks preoperation; methotrexate, doxorubicin, cisplatin, ifosfamide; continue post-op, regime use depends on histological assessment of resected tumor Surgical resection prosthesis/bone graft Radiation NOT used

X-ray: areas of bone destruction (permeatve lesion) + periosteum reaction (onion peel)

INVESTIGATIONS

METASTASIZES

Slow growing, so metastasize late. Prognosis more favourable than osteosarcoma

Exclude OM FBC (leucocytosis), ESR X-ray, CT, MRI, bone scan Biopsy: confirm dx Chest X-ray & CT scan Metastasize to the lung

CBC ( RBC, platelet, WBC), ESR, blood chemistry (hypercalcemia, serumcreatinine), bence jones protein (UPEP), abnormal band (SPEP), X-ray, biopsy, bone scan -

MANAGEMENT

RESISTANT to chemotherapy & radiotherapy So, radical excision + prosthesis/bone graft or: Amputation

Prognosis poor Combine 3 methods: chemotherapy + radiotherapy + surgical excision of primary tumor

Prognosis poor, not curable Conservative: analgesic, correct fluid, hperCA, limb/spinal # (fixation), antibiotic, decompress cord compression Chemotherapy, corticosteroid, bone marrow transplantation

References: Apleys, 3rd edition; outline of orthopedic, 13th edition; http://orthoinfo.aaos.org/main.cfm; http://www.bonetumor.org/welcome-bonetumororg-webs-most-comprehensive-bone-tumor-resource

Prepared by: zonnahalid 4th year medical student of UiTM